Background: Belotecan (Camtobell, CKD-602, Chongkundang Pharm., Korea), a camptothecin derivative, has anticancer effects by inhibiting topoisomerase I such as topotecan. This study observed the response, survival and toxicity of belotecan monotherapy after the failure of etoposide and platinum (EP). Methods: Forty nine small cell lung cancer (SCLC) patients (M/F=41/8; age, 64.5±7.6 (mean±SD) years), who failed in their first line chemotherapy were enrolled in this study. Twenty one SCLC patients showed relapsed lung cancer more than 90 days after their prior EP chemotherapy (sensitive relapse group, SR) and 28 patients relapsed within 90 days (refractory relapse group, RR). Results: The response rate was 25%. Eleven patients showed partial responses and 5 patients could not be checked. The response rate of the SR and RR patients was similar. The relative dose intensity was lower in the responders (78±15%) than non-responders (83±13%, p=0.03). The median survival time (MST) was 10.3 months (290 days). The MST of the non-responders and responders was 186 days (95% CI; 67~305) and 401 days (95% CI; 234∼568, p=0.07), respectively. The median progression free survival (MPFS) was similar in the SR (79 days) and RR (67 days) patients. Grade 3~4 neutropenia, anemia, and thrombocytopenia were observed in 59.6%, 12.8% and 23.4% of patients, respectively. Conclusion: The efficacy and survival were demonstrated in the second-line setting. However, a randomized comparative trial with topotecan will be needed.
Background: Pulmonary Langerhans cell histiocytosis (PLCH) is characterized by a proliferation of Langerhans cells and this results in granulomas that involve multiple organs of the body. Because the incidence of PLCH is very low in Korea and worldwide, collecting the clinical data of patients with PLCH nationwide is needed to determine the clinical features of Korean patients with PLCH. Methods: The patients with PLCH confirmed by biopsy at any body site were included and the patients should have lung lesions present. A questionnaire that had items on the symptoms, lung function tests, the roentgenographic findings and the treatment was collected retrospectively at a Korean ILD Research Meeting. Results: A total of 56 cases were collected. The number of males and females was 48 and 8, respectively, and their median age was 43 years (range: 18∼67 years). The patients were current or ex-smokers in 79% of the cases. The most frequent symptom was coughing (39%), followed in decreasing order by dyspnea (38%), sputum (20%) and chest pain (20%). Pneumothorax was observed in 16 (29%) patients. Lung function tests showed a normal, restrictive, mixed or obstructive pattern in 26 (61%), 7 (16%), 7 (16%) and 3 patients (7%), respectively. Nodular-cystic lesion was most frequently observed in 59% of the patients on HRCT. The lung lesions were located in the middle and upper lobes in almost the cases. The median follow-up period was 90 months (range: 1∼180 months) and only two patients died during this period. Conclusion: This study provides a national survey of the patients with PLCH during a long follow-up period.
Background: Anemia is quite common in lung cancer patients and known to decrease the quality of life. Darbepoetin alfa is an erythropoiesis-stimulating protein approved for administration to cancer patients. This study examined the efficacy and safety of darbepoetin alfa in lung cancer patients with a hemoglobin concentration＜10 g/dl during chemotherapy. Methods: Lung cancer patients (n=178) received darbepoetin alfa at doses of 1.91 μg/kg per week until the hemoglobin concentration increased to ＞10 g/dl. The efficacy and safety were measured by comparing the hemoglobin concentration and assessing the adverse events. Results: After chemotherapy, the hemoglobin concentration decreased to 9.03±0.64 g/dl. With the darbepoetin alfa treatment, the hemoglobin concentration increased to 10.09±1.17 g/dl after 4 weeks reaching a peakhemoglobin concentration of 10.45±1.18 g/dl. The changes in hemoglobin after 4 and 8 weeks with treatment were 1.08±1.24 g/dl and 1.38±1.59 g/dl (p＜0.01). At least a 1 g/dl or more increase in hemoglobin was observedin 62.4% of patients. There were no serious adverse effects except for some mild reactions. Conclusion: Darbepoetin alfa administered to lung cancer patients appears to be an effective, well-tolerated treatment for chemotherapy induced anemia.
Background: A forceps-biopsy is performed to acquire tissue from patients with an endobronchial carcinoma using a flexible bronchoscope. Recently, a cryo-biopsy has also been used to acquire tissue samples. Cryo-biopsy is the diagnostic application of extreme cold for the local destruction of abnormal living tissue. This technique is safe, with no radiation danger, no risk of electrical accidents, and a little risk of bleeding. This study compared a forceps-biopsy with a cryo-biopsy using a flexible bronchoscope, and examined the chemosensitivity and level of VEGF (vascular endothelial growth factor) in the specimens obtained from the cryo-biopsy. Methods: We present a prospective study of 30 consecutive patients who underwent a forceps-biopsy between January 2007 and October 2007 with a mean age of 62.1 years and a male:female ratio of 5 : 1. A flexible bronchoscope was inserted to the area of the abnormal lesions, and a cryo-probe was then applied through the working channel of the flexible bronchoscope. A temperature of approximately −80 was delivered to the tumor site for 8 seconds. The cryo-biopsy was performed after destroying the tumor mass. Results: The mean size of the tissue from the forceps-biopsy and cryo-biopsy were 2.0±1.2 mm and 6.0±3.0 mm. A chemosensitivity test was performed on 5 specimens obtained using cryo-biopsy and the level of VEGF was examined in 2 specimens obtained from a cryo-biopsy. There were no side effects in either group. Conclusion: Cryo-biopsy using a flexible bronchoscope is a safe and effective technique for acquiring tissue samples.
Background: Tsutsugamushi, leptospirosis and hemorrhagic fever with renal syndrome (HFRS) are the prevalent diseases among the acute febrile illnesses in Korea. Pulmonary involvement in the patients with these diseases remains poorly recognized in endemic regions, and this is despite reports of recent outbreaks and epidemic episodes. Pulmonary involvement and a higher CRP level as clinical manifestations show a more severe form of infection. The aim of this study is to analyze the correlation of pulmonary involvement and the CRP level in patients with acute febrile illnesses. Methods: We retrospectively reviewed the clinical records of 105 patients who were diagnosed with tsutsugamushi, HFRS and leptospirosis from January 2002 to May 2008 in Chuncheon Sacred Heart Hospital. The radiographic images were retrospectively analyzed by two radiologists. We analyzed the pulmonary complications of the patients with these febrile diseases and we checked the CRP level at admission. Results: The study included 105 patients who were diagnosed with febrile diseases. Of these patients, 32 patients had hantaan, 10 patients had leptospirosis and 63 patients had tsutsugamushi disease. 42 (40%) patients had pulmonary complications, 20 patients had pulmonary edema, 20 patients had pleural effusion and 2 patients had interstitial pneumonitis. The patients with pulmonary involvement showed a more severe form of infection and a higher CRP level than that of those patients without pulmonary involvement (p=0.0073). Conclusion: Pulmonary involvement in patients with acute febrile diseases might be correlated with a higher CRP level. Identification of this factor on admission might provide useful selection criteria for the patients who need early intensive care.
Despite the improvements in supportive care, early and late hematopoietic stem cell transplantation-related complications still remain a significant cause of morbidity and mortality. Pulmonary complications occur in 40∼60% of patients who undergo allogeneic hematopoietic stem cell transplantation. Late-onset noninfectious pulmonary complications can occur months and even years after transplantation. Interstital lung disease has also been reported to be a late post-transplant complication. Exposure to cytotoxic drugs and/or irradiation has been implicated as a cause of pulmonary toxicity including pulmonary fibrosis. We report a case of an 18-year-old female with non-classifiable interstitial pneumonia that manifested eight and a half years after allogeneic hematopoietic stem cell transplantation. The condition worsened rapidly and the patient eventually died.
Most mediastinal teratomas are histologically well-differentiated tumors and benign. The majority of patients with a mediastinal teratoma are asymptomatic and their tumors are usually discovered incidentally on chest radiography. On rare occasions this tumor will rupture spontaneously into the adjacent organs. A 72-year-old female patient was admitted for dyspnea and she had a multiloculated pleural effusion in the left lung field. Although repeated pleural biopsy and pleural fluid cytology did not prove the presence of malignancy, we assumed that this was a malignant effusion because it revealed consistently high levels of carcinoembryonic antigen and carbohydrate antigen 19-9, and the chest CT scan did not show typical fat or bone density in the mass. Secondary infection and an uncontrolled septic condition due to pleural empyema finally compelled the patient to undergo a surgical operation. Mature teratoma was the final diagnosis and she has done well without recurrence for 2 months.
Spontaneous regression is extremely rare in lung cancer and this in spite of its global high incidence. So far, less than 30 such cases have been reported in the literature. We report here on the case of a 68-year-old man who had the diagnosis of adenocarcinoma and in absence of any medical therapy, he had a partial spontaneous regression of tumor.
Bronchogenic cyst arises from anomalous budding of the primitive foregut during embryonic development and it represents a part of the spectrum of bronchopulmonary foregut malformations. Approximately two-thirds of the malformations are found within the mediastinum, and one-third are found in the lung parenchyma. The prevalence of bronchogenic cyst is unknown, presumably because most patients are asymptomatic. Incidentally detected bronchogenic cysts are usually removed at the time of diagnosis. We do not know how and why bronchogenic cysts grow. We recently experienced a case of rapidly growing mediastinal mass in a young adult, and this presented as a huge mass that had newly developed within one year. This mass was pathologically confirmed to be a bronchogenic cyst. We report on this case of a rapidly growing bronchogenic cyst, which is a rare characteristic of this type of cyst.
Background: There is limited data on the epidemiology and relative frequency of idiopathic interstitial pneumonia(IIP) worldwide. This survey was performed to assess the epidemiology and relative frequency of IIP in Korea. Methods: The patients with IIP and who were confirmed by lung biopsy, except those patients with idiopathic pulmonary fibrosis, (IPF) over a 5 year period (from Jan. 1st, 2003 to Dec. 31st, 2007) were registered by a web-base questionnaire. Results: A total of 3,156 cases were registered, but 970 cases were excluded due to duplicative registration, inadequate data and the unmet ATS/ERS diagnostic criteria. A total of 2,186 cases were analyzed. The male to female ratio was about 2 : 1 and their mean age was 65 (range: 11∼94). The most frequent disease was IPF (77.1%), followed in decreasing order by nonspecific interstitial pneumonia (NSIP) (11.9%), cryptogenic organizing pneumonia (COP) (8.5%), acute interstitial pneumonia (AIP) (1.1%), esquamative interstitial pneumonia (DIP) (0.9%), respiratory bronchiolitis-interstitial lung disease (RB-ILD) (0.4%) and lymphocytic interstitial pneumonia (LIP) (0.1%). The mean age of the patients with IPF, NSIP and COP was 67.8, 57.1 and 57.7 years old, respectively. The most frequent symptom was dyspnea on exertion (69%) followed by coughing (61%) and sputum (33%) for the whole population. The three year survival rate was 62% for the patients with IPF and the five year survival rate was 85% in both the NSIP and COP patients. Conclusion: This survey provides helpful information for the management of IIP and to produce management guidelines for this illness in Korea.